Inspection visit
Fire Safety inspection
Citations
13 citations recorded*CMS
This is a Fire Safety survey. CMS cites these findings under the Life Safety Code and Emergency Preparedness rules, a separate set from the health (F-tag) deficiencies. The codes and grading differ, so these do not link to the health violation pages.
What do CMS severity letters mean?
Serious (G-L). Actual harm to a resident, or immediate jeopardy. Codes G through I indicate actual harm; J through L indicate immediate jeopardy to resident health or safety.
General (A-F). No actual harm found, or harm that is minimal. The facility must still submit a Plan of Correction. Most CMS citations land here.
Each letter combines severity with scope: how many residents the deficiency affected.
- 0004GeneralS&S Cno actual harm
Develop and maintain an Emergency Preparedness Program (EP).
- 0006GeneralS&S Fpotential for harm
Conduct risk assessment and an All-Hazards approach.
- 0015GeneralS&S Cno actual harm
Address subsistence needs for staff and patients.
- 0032GeneralS&S Cno actual harm
Provide primary/alternate means for communication.
- 0035GeneralS&S Dpotential for harm
Provide family notifications of emergency plan.
- 0041GeneralS&S Cno actual harm
Implement emergency and standby power systems.
- 0345GeneralS&S Dpotential for harm
Have approved installation, maintenance and testing program for fire alarm systems.
- 0346GeneralS&S Cno actual harm
Follow proper procedures when the fire alarm was out of service for more than 4 hours.
- 0363GeneralS&S Epotential for harm
Install corridor and hallway doors that block smoke.
- 0712GeneralS&S Dpotential for harm
Have simulated fire drills held at unexpected times.
- 0754GeneralS&S Dpotential for harm
Provide properly sized and located linen or trash receptacles.
- 0918GeneralS&S Dpotential for harm
Have generator or other power source capable of supplying service within 10 seconds.
- 0926GeneralS&S Dpotential for harm
Ensure that personnel concerned with handling of medical gases and cylinders are trained on the risk.
FAQ · About this visit
Common questions about this visit
What happened during the February 10, 2023 survey of FREEDOM VILLAGE HEALTHCARE CENTER?
This was a inspection survey of FREEDOM VILLAGE HEALTHCARE CENTER on February 10, 2023. The surveyor cited 13 deficiencies, recorded on the federal Form 2567 statement of deficiencies.
Were any deficiencies cited at FREEDOM VILLAGE HEALTHCARE CENTER on February 10, 2023?
Yes, 13 deficiencies were cited, each with a CMS Scope and Severity grade. The first was: "Develop and maintain an Emergency Preparedness Program (EP)."
What type of survey was this?
This was a inspection survey conducted by state surveyors under federal Centers for Medicare & Medicaid Services (CMS) oversight. Findings are published on CMS Care Compare.
SourceView on CMS Care Compare
Next steps
Concerned about a resident’s care?Find your local ombudsman through the Eldercare Locatoror file a complaint with your state survey agency.
Researching this visit professionally?Book a 15-minute calland we will walk through what we have on file.
Data from CMS Care Compare public records. Dataset last refreshed . If you believe any information is inaccurate, report it here.